Equity in Receipt of a Lumbar Puncture for Febrile Infants at an Academic Center.
Hosp Pediatr
; 13(3): 216-222, 2023 03 01.
Article
em En
| MEDLINE
| ID: mdl-36785977
ABSTRACT
BACKGROUND:
The evaluation of febrile infants ≤60 days of age is often guided by established protocols. However, structural racism and physicians' implicit bias may affect how such clinical guidelines are applied.OBJECTIVE:
To determine the association between self-identified race, insurance type, ZIP code-based median household income (MHI) and receiving a guideline-concordant lumbar puncture (GCLP) in febrile infants.METHODS:
This was a 3-year retrospective cross-sectional study of all febrile infants ≤60 days old presenting to a children's hospital from 2015 to 2017. GCLP was defined as obtaining or appropriately not obtaining a lumbar puncture as defined by the hospital's clinical practice guideline, which recommended performing a lumbar puncture for all febrile infants ≤60 days of age unless an infant was >28 days of age and had respiratory syncytial virus-positive bronchiolitis. Univariate analyses were used to identify variables associated with receiving a GCLP. Variables with a P < .1 were included in a multivariate logistic regression with race, MHI, and insurance type.RESULTS:
We included 965 infants. Age (adjusted odds ratio, 0.95; 95% confidence interval, 0.94-0.97) and temperature on arrival (adjusted odds ratio, 1.36; 95% confidence interval, 1.04-1.78) were significantly associated with receipt of a GCLP. Self-identified race, insurance type, and MHI were not associated with receiving a GCLP.CONCLUSION:
Receipt of a GCLP was not associated with race, MHI, or insurance type. As recent national guidelines change to increase shared decision-making, physician awareness and ongoing assessment of the role of factors such as race and socioeconomic status in the clinical evaluation and outcomes of febrile infants will be critical.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Punção Espinal
/
Infecções por Vírus Respiratório Sincicial
Tipo de estudo:
Guideline
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
/
Humans
/
Infant
/
Newborn
Idioma:
En
Revista:
Hosp Pediatr
Ano de publicação:
2023
Tipo de documento:
Article